Cosmetic surgeons frown on Senate's 'botax' plan

Kaiser Health NewsNovember 20, 2009 

WASHINGTON — If you're considering Botox to erase frown lines or liposuction to get rid of love handles, you might want to move fast. The "botax" may be on the way.

The $848 billion health care bill that Senate Majority Leader Harry Reid, D-Nev., unveiled Wednesday includes a 5 percent tax on cosmetic procedures and surgeries. The tax, which would take effect in January, would raise an estimated $5 billion over the next decade to help pay for extending health care coverage to millions of Americans.

Plastic surgeons decried the proposal, saying the recession has battered their practices and they're just beginning to recover.

"This will be devastating to doctors who do cosmetic surgery," said Dr. Angela Cuzalina, a Tulsa, Okla., cosmetic surgeon.

"You'd be surprised how price-sensitive people are to this. . . . It's a tax against women and the baby boomer generation having these procedures."

Some worried that the tax would be applied to more and more procedures. "It's cosmetic surgery today, laser eye surgery tomorrow, then who knows, maybe it's the knee-replacement surgery to help you play golf," said Dr. Gary Smotrich, a plastic surgeon in Lawrenceville, N.J.

Other critics said the proposed tax also would hurt the growing number of medical spas that offer Botox and other injectables.

"Many clients are receiving Botox and fillers to maintain a competitive edge in this youth-oriented and dismal economy," said Bonnie Marting, the director of medical aesthetics at the Anushka Cosmedical Centre Spa & Salon in West Palm Beach, Fla.

Diane Archer, the director of the health care project at the Institute for America's Future, a liberal policy organization, isn't sympathetic.

"We pay taxes on virtually every good and service, and luxury goods and services should be taxed even higher," she said. "This is not a medical service. It's the equivalent of a facial or a massage. Its something that's nice to have but not necessary."

About 12 million cosmetic procedures and surgeries — which insurance typically doesn't cover — were performed last year, at a total cost of $10.3 billion, according to the American Society of Plastic Surgeons. The vast majority, 10.4 million, were minimally invasive services such as Botox injections and chemical peels. The most common surgeries were breast augmentation, liposuction and tummy tucks, but all those procedures declined at double-digit rates last year.

It's unclear exactly which services the proposed tax in the Senate bill would cover. The Senate legislation refers to the Internal Revenue Service definition of cosmetic surgery: "Any procedure which is directed at improving the patient's appearance and does not meaningfully promote the proper function of the body or treat illness or disease." There's no comparable provision in the bill the House of Representatives passed.

New Jersey, where a 6 percent levy on cosmetic procedures and surgeries took effect in 2005, is the only state with such a tax. Doctors there say many patients go to neighboring New York or Pennsylvania for the most expensive procedures to avoid the tax, which has brought in about $11 million a year, only about half as much as expected.

"It's hurt all of our practices," Smotrich said.

Plastic surgeons said the proposed federal tax would be troublesome because it would be difficult to determine which procedures were elective and which were medically necessary.

The New Jersey tax applies to such procedures as hair transplants, cosmetic injections, dermabrasion, laser hair removal, laser skin resurfacing, laser treatment of leg veins, cosmetic dentistry and breast augmentation. It doesn't apply to everything; for example, post-cancer reconstructive breast surgery isn't subject to the tax.

Plastic surgeons reject the notion that only the rich get plastic surgery, saying that many middle-class people are having the procedures, especially given the wider availability of less costly and invasive procedures and increased financing options.

Dr. Andrea Hass, a plastic surgeon in Palm Beach Gardens, Fla., said the tax wouldn't affect just the wealthy.

"This hurts the people who save money to make the down payment to help themselves look better," she said. "People will start to think twice about it."

(Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy-research organization that isn't affiliated with Kaiser Permanente.)

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